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Tuesday, August 28, 2012

I'm very excited about my new promo piece. It's postcard size and I think they turned out great!

What is a doula?

A Doula is a trained professional who provides physical, emotional, and educational support throughout pregnancy, childbirth, and the postpartum period. A labor doula helps a woman prepare for birth and provides a range of labor support techniques and comfort measures. She is a birth advocate who encourages informed consent and strives to improve a mother’s self confidence.

Research shows that women who are cared for by a doula are:

26% less likely to give birth by Cesarean section

28% less likely to use any analgesia or anesthesia

33% less likely to be dissatisfied or negatively rate their birth experience

41% less likely to give birth with a vacuum extractor or forceps

Doulas provide non-medical services that supplement those of medical staff such as doctors, nurses, or midwives. However, a doula stays with you throughout your entire labor & delivery.

Tuesday, August 21, 2012

I recently watched The Business of Being Born for the second time. The first time I saw it was almost 5 years ago. It was interesting to note the difference in my reaction this time around. I still maintain that every expectant family should see this film!Personally, I'm excited to watch their new film, MORE Business of Being Born.

THEN

I saw the film at a pre-screening about a year after the traumatic birth of my daughter.

I didn't recognize a single person in the film aside from Ricki Lake.

The C-section in the film bothered me. In a way, I almost felt it made the film a failure. I wanted the film to show how wonderful homebirth can be resulting in low, low rates of transfer.

NOW

I'm now a certified doula and have processed and healed from my birth experience.

I immediately recognized probably 75% of the experts they interviewed and knew them by name without having to read the subtitle.

I'm glad the C-section was included because it shows how well a midwife and backup doctor can work together to get the care that mom needs when an emergency arises. However, I don't think they did a great job of explaining why she needed to transfer. I know enough now that I was able to figure it out and then confirmed my theory by watching the interviews in the bonus features. Here's the explanation. Not everyone is a candidate for homebirth. Abby was a candidate until she went into early labor with a breech baby. The combination risked her out of homebirth. At the hospital, we learn that the baby had intrauterine growth restriction (IUGR). This explains why mom was measuring so small earlier in the film. IUGR babies have big heads and small bodies. This is not a good combination with a breech baby as the body can emerge but the head get stuck. Therefore, a Cesarean was warranted. So, I'm totally okay that they included this in the film because it wasn't an unncecessarean. I just wish that it would have been explained better.

Moving on, here are some of my favorite quotes from the movie and points raised by the theme of the film. I missed a few of the speakers/titles but tagged the ones I knew. Still, you just need to watch it. It's SO good! The preview/trailer is at the bottom of this post.

U.S. MATERNITY CARE

Maternity care in the United States is in crisis. - Dr. Marsden Wagner

What the medical profession has done over the last 40-50 years is convince the vast majority of women that they don't know how to birth. - Nadine Goodman, Public Health Specialist

Are we benefitting mothers and babies or not? - Ricki Lake

The U.S. has the 2nd worst newborn death rate in the developed world. The U.S. has one of the highest maternal mortality rates among all industrialized countries.

When you look at our data and the amount of money we spend versus the outcomes we get, it sucks! There are countries who spend a third of what we have and have a lower infant mortality so more doesn't mean more in this case and maybe less is more. - Dr. Jaquez Moritz, OB/GYN Saint Luke's Roosevelt Hospital

People in our culture spend more time and effort researching to buy a stereo system, a car, probably a camera than they do checking out what their choices are for birth.

What we have to rediscover is that birth can be easy when we don't try to make things too complicated.

MIDWIVES

Midwives attend over 70% of births in Europe and Japan and less than 8% in the United States.

Trained homebirth midwives are incredibly skilled at what they do. The fact of the matter is that they bring pitocin, oxygen, equipment for suturing, and recessitation of the baby.

For a normal, low-risk woman it's overkill going to a doctor, it's just too much. The doctor is not really excited about things when they are normal. - Dr. Jaquez Moritz, OB/GYN Saint Luke's Roosevelt Hospital

HOMEBIRTH

In 1900, 95% of births in the U.S. took place at home. In 1938 it was 50%. By 1955, it was less than 1%.

In a supported environment the outcomes of homebirths are very, very good and consistently at least as good and generally better than a hospital birth. - Eugene Declerq, Ph.D. Professor of Maternal & Fetal Health Boston University

We spend twice as much in this country, per birth, than any other country in the world. This is one of those very rare instances where cheaper is truly better. - Dr. Marsden Wagner

C-SECTIONS

There is clearly an association of induction and cesarean delivery. - Dr. Michael Silverstein OB/GYN

The cesarean rate climbed from 4% to 23% after the introduction of the electronic fetal monitor. - Robbie Davis-Floyd, medical anthropologist

There was a study that came out many years ago, which showed that if you looked over a 24 hour period the peaks in C-sections were 4 in the afternoon and 10:00 at night. - Dr. Michael Brodman Chairman of Dept of OB/GYn at Mount Sinai Hospital

The literature is very clear that having a vaginal birth statistically is the way to go. Dr. Michael Brodman Chairman of Dept of OB/GYn at Mount Sinai Hospital

EMOTIONS

A woman, as long as she lives, will remember how she was made to feel at her birth - Anna, doula.

Many people have described birth as a right of passage and it is certainly a life-altering experience and it can be a beautiful, incredible, empowering life-altering experience or it can be a devastating, traumatic, scarring, literally and figuratively, experience.

What are the basic needs of women in labor?

We knew that feelings affected birth. - Ina May Gaskin, Founder of The Farm Midwifery Program

HORMONES

You get the highest oxytocin rush that you will ever get in your life when you give birth naturally. - Robbie Davis-Floyd, medical anthropologist

In monkeys, if they give birth by C-section they are not interested and will not take care of their babies because the love-hormone cocktail is not released. So you wonder, but what about our civilization, what about the future of humanity. If most women have babies without releasing this cocktail of hormones, can we survive without love?

Saturday, August 18, 2012

There were two things that drew me to this book. For one, I find the history of childbirth in America very interesting. I'm fascinated with how advances were discovered, why masses of women made the choices they did, and to watch how we have come full circle and see that homebirth is on the rise again. The second part was simply the fact that the author's last name is the same as the producer of The Business of Being Born. I've yet to find any evidence that they are related but it was a point of interest for me nonetheless.

This book addresses the original birth plan (homebirth) and goes on to discuss the changes in maternity care such as forceps, hospital birth, twilight sleep, fertility drugs, C-sections, ultrasound, and artificial insemination. I'm not typically good with random historical facts but I found the bit about how forceps totally intriguing. They were created by The Chamberlens, a family of man-midwives, and it ultimately became a very effective marketing tool. They had the highest rates of getting babies out and keeping mothers alive. In fact, their instrument was a highly kept secret for 200 years. They were carried in a large, heavy, wooden box and were only used after everyone else had left the room and a sheet was draped over the mother so as to prevent even the woman from having a peek at the gadget.

I had a very difficult time reading through the advances of Dr. Marion Sims. While he made the most progress in dealing with fistulas (a side effect of extreme and prolonged pushing), he did it at the cost of operating on slave women and bore them no dignity or privacy in the process.

It's interesting to note how the opinions of women changed over the years. In fact, doctors were not favored at all and many Lying-In (maternity) Hospitals were transferring Childbed Fever from patient to patient until the germ theory was discovered and hand washing and general hygiene became the standard. When rumors of "twilight sleep" hit the U.S., women demanded pain-free childbirth. What they didn't realize was that the delivery was anything but pain free. Basically, the drugs caused them to forget. In essence, it's like it never even happened. Ironically enough, most American physicians were not on board with giving this drug cocktail but women fought back until they got what they wanted.

I once read (in another source) that it takes 20 years for proven research to become practice. This was certainly evident in this text. For example, it was absolutely true in the case of Childbed Fever as doctors refused to believe that they were responsible for making the women sick. X-rays of the female pelvis began in 1930s. In 1956 a study showed that they could cause cancer but they were still routinely used in pregnancy until the 70s. In the 1950s natural childbirth started making a comeback but didn't become a full-fledged movement until the 70s. This 20-year phenomenon was again evident with the drug DES (estrogen therapy). It was used to sustain a pregnancy but 20 years later they determined that it had effects in the female offspring causing cancer or sterility. It took another 20 years before it was finally taken off the market. Seems ludicrous, right?! Yet, even now we are facing the same question with ultrasound. Wonder how long we will continue down this path until they stop using it so frequently?

The last two chapters of Get Me Out deal with technological advances for freezing sperm, eggs, and embryos. Again, I was fascinated. I was reminded of how perfect yet complex the body is and that creating and sustaining a pregnancy is more of a miracle than we often realize. The ability to create life almost instantaneously and at the time of our choosing will certainly have an affect on our society. Time will tell just how much.

I rather enjoyed this story and the author writes in a way that is factual yet comical. I did indeed laugh out loud a few times. Most of the "techniques" she writes about seemed perfectly logistical at the time yet they are quite shocking and laughable in the 21st century. Still, I think it's always important to know exactly how we have arrived at our current state of affairs. We've made huge advances yet it seems we still have a ways to go.

Saturday, August 11, 2012

In humans

In human females, the nesting instinct often occurs around the fifth month of pregnancy[1][4], but can occur as late as the eighth, or not at all[citation needed]. It may be strongest just before the onset of labor.[1][5][6]

It is commonly characterized by a strong urge to clean and organize one's home and is one reason why couples who are expecting a baby often reorganize, arrange, and clean the house and surroundings.

While nesting is common in the last few days of pregnancy, I find that I am also particularly prone to nesting at other times in my life. For example, I often "nest" at the beginning of a new year or right before school gets out and then again right before school starts back. I am likely to go into a cleaning frenzy right before I start a new project at work or anytime something new is on the horizon for our family. I'm a type A personality and I function much better when all of my little ducks are in a row. Over time, I've discovered that my nesting instinct (which is just a nicer way of saying I obsessively clean, organize, purge, and tidy) occurs when I am feeling out of control. If there is some aspect of my life that I don't feel I have a firm grip on, I overcompensate by controlling something else, the tidiness of my home. It's kind of become a running joke around here.

When my doula clients reach 38 weeks, I go "on call" meaning that they can contact me 24/7 and I am ready at a moment's notice (preferably an hour) if mom feels that she is in active labor and needs me. My doula bag stays in the car, the car stays full of gas, I don't go out with the girls for margaritas, I arrange plan B for childcare, and I make an effort to get a decent night's sleep.

I often talk with my clients about the nesting instinct and how that big surge of energy and desire to prepare the home can be a sign of impending labor. I've found that I also tend to nest right along with the expectant mom. Part of it comes just from the lack of control as I firmly believe that babies should choose their own birthdays. Since cleaning is my coping mechanism, I use it to make up for the waiting game. But, when I have a suspicion that a client may be going into labor soon (next day or so), my nesting instinct goes into high gear. I never know how long I'm going to be away from home, so I like for everything to be easily accessible for my husband and daughter. I prep food, lay out clothes, pack school and extracurricular bags, and put my "village" of helpers on alert. I know that they could easily survive on their own but it makes me feel better to know I've left a good environment for them. I am the one who manages logistics for our family on a daily basis so I also leave behind plenty of notes hoping that no steps get missed.

I'm wondering if other doulas have experienced this nesting instinct right before a client goes into labor. Maybe this will get better with time as I become more seasoned. Your thoughts are welcomed in the comments below.

Thursday, August 9, 2012

Tennessee Cesarean Rates by Hospital, 2010 - This is the most up-to-date information we have in my state. Unfortunately all hospitals are not required to release this information. One big hospital in Nashville, Centennial Women's Center, is missing from this report. Makes me wonder how high theirs is. For my area, Vanderbilt seems to have the lowest (31.5%) rate.

Cesarean Section Rates in the United States - This is from the AGOG website and shows rates from 1970 until 2006. Interestingly, this chart also shows the VBAC rate. I found it fascinating that only 10% of women were getting to VBAC in 2006, when it has been as high as 28% just a decade earlier.

The Evidence for Skin-To-Skin Care After a Cesarean - "The benefits of skin-to-skin care are so clear that the World Health Organization recommends ALL newborns receive skin-to-skin care, no matter the baby’s weight, gestational age, birth setting, or clinical condition."

Birth by the Numbers - This man knows his numbers and breaks down years of stats and research into a nifty little video. You can also download the powerpoint slides.

ObGyns Issue Less Restrictive VBAC Guidelines - Straight from the mouth of the governing body for obstetricians. "The current cesarean rate is undeniably high and absolutely concerns us as ob-gyns. These VBAC guidelines emphasize the need for thorough counseling of benefits and risks, shared patient-doctor decision making, and the importance of patient autonomy. Moving forward, we need to work collaboratively with our patients and our colleagues, hospitals, and insurers to swing the pendulum back to fewer cesareans and a more reasonable VBAC rate." - Richard N. Waldman, MD, president of The College

Should There Be a Limit on Cesareans? - "But now the WHO states that "there is no empirical evidence for an optimum percentage" and stresses that "what matters most is that all women who need Caesarean sections receive them"." <---- While I disagree with this new position, this article raises some very interesting points about women's choice as well as what factors may be contributing to a higher C-section rate.

Trial of Labor is a new documentary coming out and I am very anxious to see it. It follows 4 women who had a primary C-section and are pursing a VBAC. The trailer is below. If you would like to suppor the film, click here.

Friday, August 3, 2012

From the World Health Organization - "World Breastfeeding Week is celebrated every year from 1 to 7 August in more than 170 countries to encourage breastfeeding and improve the health of babies around the world. Breastfeeding is the best way to provide newborns with the nutrients they need. WHO recommends exclusive breastfeeding until a baby is six months old, and continued breastfeeding with the addition of nutritious complementary foods for up to two years or beyond."